Legislature(2013 - 2014)SENATE FINANCE 532
04/04/2013 02:30 PM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB88 | |
| SB74 | |
| HB22 | |
| HB26 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 22 | TELECONFERENCED | |
| + | HB 26 | TELECONFERENCED | |
| += | SB 88 | TELECONFERENCED | |
| += | SB 18 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 88
"An Act authorizing the state bond committee to issue
certificates of participation to finance the
construction and equipping of residential housing to
serve the Anchorage campus of the Alaska Native
Medical Center; and authorizing the Department of
Administration to enter into a lease-purchase
agreement for the benefit of the Alaska Native Tribal
Health Consortium."
2:44:46 PM
Co-Chair Meyer noted that the bill had been previously
discussed in committee. He believed that the question that
remained before the committee was whether the project
should be paid for up front with capital dollars, or should
it be bonded for, with interest being paid on the bond. He
admitted that the state was short funds for capital
projects, but that the project proposed in the legislation
was financially feasible because of solid revenue sources.
2:46:37 PM
Co-Chair Meyer queried whether the department assigned to
fiscal note number 1, for $35 million in estimated capital
costs, should be the Department of Administration (DOA) or
the Department of Revenue (DOR).
2:47:25 PM
ANGELA RODELL, DEPUTY COMMISSIONER, TREASURY DIVISION,
DEPARTMENT OF REVENUE, replied that the state would sell
certificates of participation by DOR through the State Bond
Committee. She relayed that the certificate represented the
sale of participation in a lease agreement. She furthered
that DOA would then take the proceeds of the transaction
and hold them; the department would receive invoices as the
project was under construction and would be in contact with
the Department of Health and Social Services to ensure that
the expenses were what had been agreed upon in the lease
agreement. She stated that once the facility was open DOR
would lease the building from DOA for 15 years; the lease
payments made would be used to repay the certificates of
participation. She stressed that the amount of Medicaid
savings generated through use of the facility would reflect
positively on the state's general fund.
2:49:20 PM
WILLIAM STREUR, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES, commented that approximately 40 percent of
the services currently provided to Alaska Natives were done
through a native run system, which left 60 percent on the
table. He said that assuming that 20 percent of specialty
services were not available within the tribal system, or in
Alaska, a 40 percent doubling of services could be provided
by the tribal system. He thought that by moving as many
services as possible over to the tribal system, the state
would receive a 100 percent match from the federal
government, resulting in less spending of general fund
dollars. He noted that that the bill was a step towards
getting tribal members medical help within the tribal
system. He shared that receiving services consistently
within the tribal system would result in continuity of care
for recipients. He pointed out that there was a $1.1
million projected savings for general child health. He
relayed that many surgeries currently being performed could
be done through the tribal system, and would allow for
better care prior to and immediately after surgery. He
noted that ear, nose, and throat problems were prevalent in
rural communities. He thought that the expanded capacity
could result in a savings of $650,000. He spoke to
telemedicine, which he believed was underutilized. He said
that travel expenses were ever increasing in the state and
that the memorandum of understanding had to include the
continued development of telemedicine capabilities.
2:54:51 PM
Co-Chair Meyer queried what was included in the memorandum
of understanding.
Commissioner Streur listed the items in the memorandum:
cost based reimbursement for Medicaid recipient's room and
board, preferential status for Medicaid recipients to
assure priority access, required necessary transport, pre-
maternal Medicaid services. He believed that the best
Benefit to the state would be to ensure that the next
generation received the best possible care.
2:55:31 PM
Co-Chair Meyer inquired if the committee had a copy of the
memorandum of understanding.
Commissioner Streur replied that he could provide the
document to the committee.
2:55:43 PM
Commissioner Streur continued to discuss the memorandum of
understanding. He said that the designated use of the
facility must be maintained for the term of the bond. He
stated that access and utilization of the services must
continue to be developed under the terms of the bond.
2:57:39 PM
Co-Chair Meyer reiterated his desire for a copy of the
memorandum of understanding. He requested further
clarification concerning the $35 million in capital funds
under DOA, rather than DOR, as reflected in the fiscal
note.
2:57:54 PM
Ms. Rodell replied that once the bonds were sold, DOR would
not administer the proceeds; the proceeds would be turned
over to DOA because DOA would be entering into the lease
agreements on the state's behalf.
2:59:05 PM
Co-Chair Meyer welcomed Senator Bishop and Vice-Chair
Fairclough to the committee table.
2:59:33 PM
Co-Chair Kelly inquired whether Alaska Native Tribal Health
Consortium (ANTHC) would be able to pay for additional
costs if the project ran over budget.
Ms. Rodell referred the question to representation from
ANTHC.
3:00:03 PM
Vice-Chair Fairclough queried how the state would ensure
that contractors received their payments.
Ms. Rodell replied that the invoices of payment would come
to DOA, which she expected would coordinate with the
Department of Health and Social Services (DHSS).
3:01:14 PM
Vice-Chair Fairclough wondered how the cost estimation of
the project had been determined before the project
contractor had been selected.
Commissioner Streur referred the question to ANTHC.
3:01:59 PM
Vice-Chair Fairclough asked if the commissioner had
reviewed the cost estimate documents associated with the
project.
Commissioner Streur replied yes. He added that the
department would continue to review blueprints and cost
estimates along with DOR and DOA.
3:02:37 PM
VALERIE DAVIDSON, ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
(ANTHC), testified that the ANTHC would be responsible for
operation and maintenance of the facility once construction
was complete. She shared that the facility design included
six floors; 5 of the floors would be financed by the state,
but ANTHC would finance the 6th floor for patient education
with a particular emphasis on well-baby and well-mother
care. She relayed that tele-medical services would be made
available in order to help homesick patients during longer
hospital stays far from home. She stated that ANTHC
recognized the need for a meaningful partnership with the
state and was currently financing part of the facility. She
highlighted that ANTHC had a positive track record of
building facilities on-time and under budget. She shared
that she had negotiated a number of agreements for services
that had been clear and effective. She noted Commissioner
Streur had been a diligent advocate for the state in
negotiations. She stated that the issue of access to care
came up at every board meeting; the key to better access to
healthcare for people living outside of Anchorage was
housing.
3:08:28 PM
Co-Chair Meyer restated the question raised by Vice-Chair
Fairclough concerning the fiscal noted for $35 million. He
asked how the contracts would be awarded.
Ms. Davidson replied that in addition to co-managing the
Alaska Native Medical Center, the consortium had a large
construction sector of its organization. She said that the
consortium had a short list of contractors that would be
meeting in the future to examine opportunities and review
proposals.
3:09:49 PM
Co-Chair Kelly queried if ANTHC would cover any cost
overruns.
Ms. Davidson replied that cost overruns were not
anticipated; however, if additional funds became necessary
to finish the project, ANTHC would not request the funds
from the state.
3:10:24 PM
Co-Chair Meyer inquired if language pertaining to cost
overruns had been included in the memorandum of
understanding.
Ms. Davidson replied in the affirmative.
3:10:34 PM
Senator Bishop directed the committee to Page 2, line 8 of
the bill. He requested assurances on the record that Alaska
hire would be at the forefront of the hiring process.
Ms. Davidson responded that hiring Alaskans was important
on all ANTHC projects throughout the state. She added that
the consortium had a tribal preference policy as well. She
stated Alaskans took pride in working on projects that
would directly benefit Alaskans.
3:12:49 PM
Senator Dunleavy inquired if there had been survey done to
highlight why patients would use the new facility rather
than receive services at already established medical
centers.
Ms. Davidson responded that conversations with
beneficiaries that had chosen to receive care elsewhere had
revealed several things: By law, Medicaid required patients
to be offered a choice as to where they received care; many
patients had requested ANTHC centers in order to be close
to family. She added that ANTHC centers allowed for
patients to be connected to their communities in ways that
other places could not provide. She pointed out that
transportation issues were one of the greatest challenges
for people traveling to Anchorage for health services. She
stressed that ANTHC would provide transportation from the
airport to the housing facility, and that all of the
services the patient would need could be provided under one
roof.
3:16:09 PM
Senator Dunleavy queried if there had ever been a formal
survey conducted that compared the services provided in
ANTHC facilities with services provided by other hospitals.
Ms. Davidson stated that she did not know of a formal
survey. She said that the consortium conducted regular
customer experience surveys, which were then compared to
surveys conducted by other facilities.
3:16:46 PM
Senator Dunleavy appreciated that the federal government
required that a choice be given to patients concerning
where they would receive their medical care. He wondered if
the people would still chose to go to Providence Hospital
if they were given the choice of the new facility.
Ms. Davidson replied that there were services that ANTHC
was not yet at capacity to provide. She stated that, even
with all of the expansion described in their business plan,
the ANTHC facility's ability to accommodate patients was
finite. She noted that there was $30 million in general
funds that went to non-tribal facilities in Anchorage in
order to provide care for Alaska Native Medicaid
beneficiaries. She estimated that building the facility
would result in an annual savings of $8.8 million. She
pointed out that ANTHC operated the only level 2 trauma
center in Alaska and was a "magnet hospital" with a high
level of quality care provided by nursing staff.
3:20:05 PM
Senator Dunleavy wondered if the facility would be able to
accommodate patients at the same rate as Providence
Hospital.
Ms. Davidson replied yes.
3:20:37 PM
Senator Hoffman queried how long it had been since Ms.
Davidson had been staff to a previous Senate Finance Co-
Chair.
Ms. Davidson replied that it had been 27 years.
3:21:23 PM
Vice-Chair Fairclough opined that more general fund dollars
would expedite the process.
3:21:46 PM
Co-Chair Kelly MOVED to REPORT SB 88 28-LS0629\N out of
committee with individual recommendations and the
accompanying fiscal notes. There being NO OBJECTION, it was
so ordered.
3:22:06 PM
SB 88 was REPORTED out of committee with a "do pass"
recommendation and with a fiscal impact note from the
Department of Administration, a fiscal impact note from
Department of Health and Social Services, and a fiscal
impact note from the Department of Revenue.
3:22:14 PM
AT EASE
3:26:21 PM
RECONVENED
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